SKIN CONDITIONS
Onychomycosis (fungal nail infection)
Onychomycosis is a fungal nail infection causing discolouration and thickening.
- Other nail conditions can look similar
- Diagnosis before choosing treatment
- Improvement takes time as the nail grows
Onychomycosis is a fungal infection of the nail (including the nail bed in addition to the nail itself). Toenails are affected more commonly than fingernails. In Australia, about 10% of the population is affected by onychomycosis.
Risk factors include increasing age and diabetes. A fungal nail infection is not proof of poor hygiene.
It is the most common nail condition in adults – 50% of all nail diagnoses are onychomycosis.
Symptoms of onychomycosis
In onychomycosis, nails change colour, often turning yellow, brown, or white. They may become thickened and rough, with ragged edges and tears. Infected nails can also lift off the nail bed, causing pain and tenderness. The surrounding skin may also show signs of fungal infection, such as redness, itch, or scaling.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
Discoloured toenail of onychomycosis
Thickened and scaly toenail of onychomycosis
Diagnosis of onychomycosis
A doctor can usually diagnose onychomycosis by examining the nails.
The diagnosis can be confirmed by taking nail clippings and analysing them. Tests performed include:
- Microscopic examination for visual signs of fungi.
- PCR examination for fungal DNA.
- Culture (i.e. attempting to grow fungal organisms).
Microscopic examination sometimes fails to detect evidence of fungal infection, and fungal culture takes many weeks to produce results. Fungal PCR is a newer technique that can detect evidence of fungal infection within a few days.
Don’t cut your nails before your appointment for onychomycosis. The nail clipping test requires 2mm to be clipped from the end of the nail. It can be useful to detect the exact organism from nail clippings as this may impact the most suitable treatment.
Treatment of onychomycosis
The aim of treatment is to kill fungal organisms.
Topical treatments such as creams and paints are sometimes effective. They usually need to be used for an extended period.
Oral antifungal agents can be effective, but they have side effects and may interact with other medications.
Laser treatment may be discussed when medication is unsuitable or has not helped. Evidence for reliably clearing the infection is limited, and a clearer-looking nail does not necessarily mean the fungus has been eliminated.
It’s also important to make it difficult for fungi to grow and to prevent reinfection. Good nail hygiene is essential.
Concerned about a fungal nail infection?
Our doctors assess fungal nail infections and discuss all treatment options — topical, oral and laser. The initial assessment may attract a Medicare rebate. No referral needed
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